Health Questionnaire
Prior to your appointment, it would be most helpful if you would kindly complete a Nutritional Therapy Health Questionnaire.
Click here to access the Questionnaire which is four pages long. Please print out the form and complete by hand.
Completing this form as fully as possible will help Dinah prepare for your appointment, i.e. doing any research indicated by your medical history, gathering appropriate handouts or other teaching materials to bring to your appointment, etc.
Once you have fully completed the form, please write "PRIVATE AND CONFIDENTIAL" on the envelope and post it to: Dinah Miller, 47 Cranbrook Road Chiswick, London W4 2LJ
Allowing for vagaries of the postal system, please post it sufficiently early to allow the completed form to arrive at least one day before your appointment.
If there is insufficient time for this to occur, (i.e. if your appointment is quite soon), please contact Dinah to discuss the situation. It may be that you will need to bring the completed form along with you to your appointment.
Please be assured that all information about your case will be held in strictest confidence, i.e. your completed questionnaire will be stored in a locked cabinet.
Thank you for your assistance in completing the form.
If possible, please bring with you to your appointment any supplements or medications you are taking.
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